{template 'common/header'}
<link rel="stylesheet" type="text/css" href="{$_W['siteroot']}addons/superman_floor/template/images/index.css" media="all">
<script>
	{if $success}
		alert('提交成功，请您及时兑奖！');
		{/if}
</script>
<body id="wrap">
<div class="card border-1px" style="margin-bottom: 0; background-color: #808080; color: #fff">
	请认真填写以下领奖信息
</div>
<div class="card" style="margin-bottom: 0; padding-left: 0; padding-right: 0">
	<form method="post" action="" id="form" onsubmit="return check_submit(this)">
		<input type="hidden" name="token" value="{$_W['token']}" />
		<input type="hidden" name="from" value="{$from}" />
		<ul class="round" style="border: 0">
			<li class="nob">
				<table class="kuang" border="0" cellpadding="0" cellspacing="0" width="100%">
					<tbody>
					<tr>
						<th>姓名</th>
						<td>
							<input class="px" placeholder="请输入姓名" id="realname" name="realname" value="{php echo htmlspecialchars($member['realname'])}" type="text" maxLength="20"/>
						</td>
					</tr>
					</tbody>
				</table>
			</li>
			<li class="nob">
				<table class="kuang" border="0" cellpadding="0" cellspacing="0" width="100%">
					<tbody>
					<tr>
						<th>电话</th>
						<td>
							<input class="px" placeholder="请输入电话号码" id="mobile" name="mobile" value="{php echo htmlspecialchars($member['mobile'])}" type="text" pattern="[0-9]{11}" maxLength="11">
						</td>
					</tr>
					</tbody>
				</table>
			</li>
			<li class="nob">
				<table class="kuang" border="0" cellpadding="0" cellspacing="0" width="100%">
					<tbody>
					<tr>
						<th>QQ</th>
						<td>
							<input class="px" placeholder="请输入QQ号码" id="qq" name="qq" value="{php echo htmlspecialchars($member['qq'])}" type="text" pattern="[0-9]{5,15}" maxLength="15">
						</td>
					</tr>
					</tbody>
				</table>
			</li>
		</ul>
		<div class="row" style="margin: 0">
			<div class="col-xs-12 text-center" style="padding: 0 30px 10px 30px; font-size: 12px; color:#f47983;">
				为了保证您能正常领奖，请提交真实联系信息
			</div>
			<div class="col-xs-12" style="padding: 0 30px;">
				<button class="btn btn-success btn-block" value="提交" name="submit" type="submit">提交</button>
			</div>
		</div>
	</form>
</div>
<hr/>
<script>
	function check_submit(form)
	{
		var realnamee = form.realname;
		if (realname.value == '') {
			realname.focus();
			return false;
		}
		var mobile = form.mobile;
		if (mobile.value == '') {
			mobile.focus();
			return false;
		}
		var qq = form.qq;
		if (qq.value == '') {
			qq.focus();
			return false;
		}
		return true;
	}
	function onBridgeReady(){
		WeixinJSBridge.call('hideOptionMenu');
	}
	if (typeof WeixinJSBridge == "undefined"){
		if( document.addEventListener ){
			document.addEventListener('WeixinJSBridgeReady', onBridgeReady, false);
		}else if (document.attachEvent){
			document.attachEvent('WeixinJSBridgeReady', onBridgeReady);
			document.attachEvent('onWeixinJSBridgeReady', onBridgeReady);
		}
	}else{
		onBridgeReady();
	}
</script>
{template 'common/footer'}


